Agresta Ferdinando, Marzetti Alice, Vigna Silvia, Prando Daniela, Porfidia Raffaele, Di Saverio Salomone
Department of General Surgery, ULSS19 del Veneto, Adria, RO, Italy.
Department of General Surgery, Emergency and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, AUSL Bologna, 40100, Bologna, Italy.
Updates Surg. 2017 Dec;69(4):493-497. doi: 10.1007/s13304-017-0444-x. Epub 2017 Apr 13.
Outcome of primary and incisional hernia repair is still affected by clinical complications in terms of recurrences, pain and discomfort. Factors like surgical approach, prosthesis characteristics and method of fixation might influence the outcome. We evaluated in a prospective observational study a cohort population which underwent primary and incisional laparoscopic hernia repair, with the use of a composite mesh in polypropylene fixed with absorbable devices. We focused on assessing the feasibility and safety of these procedures; they were always performed by an experienced laparoscopic surgeon, analyzing data from our patients through the EuraHS registry. Seventy nine procedures of primary and incisional hernia repair were performed from July 2013 to November 2015 at Santa Maria Regina degli Angeli Hospital in Adria (RO). All cases have been registered at the EuraHS registry ( http://www.eurahs.eu ); among them, we analyzed 29 procedures performed using a new composite polypropylene mesh (CMC, Clear Composite Mesh, DIPROMED srl San Mauro Torinese, Turin, Italy), fixed with absorbable tackers (ETHICON, Ethicon LLC Guaynabo, Puerto Rico 00969). We performed 23 incisional hernia repairs, 4 primary hernia repairs (1 umbilical, 2 epigastric and 1 lumbar hernia) and 2 parastomal hernia repairs. The median operation time was 65.1 min for elective and 81.4 min for urgent procedures (three cases). We had two post-operative complications (6.89%), one case of bleeding and another case of prolonged ileus successfully treated with conservative management. We had no recurrences at follow-up. According to QoL, at 12 months patients do not complain about any pain or discomfort for esthetic result. Laparoscopic treatment of primary and incisional hernia with the use of composite mesh in polypropylene fixed with absorbable devices is feasible and safe.
原发性和切口疝修补术的结果在复发、疼痛和不适等临床并发症方面仍受到影响。手术方式、假体特性和固定方法等因素可能会影响结果。我们在一项前瞻性观察研究中评估了一组接受原发性和切口腹腔镜疝修补术的人群，使用的是用可吸收装置固定的聚丙烯复合补片。我们专注于评估这些手术的可行性和安全性；这些手术均由经验丰富的腹腔镜外科医生进行，并通过EuraHS注册中心分析我们患者的数据。2013年7月至2015年11月期间，在阿德里亚（RO）的圣玛丽亚·雷吉娜·德格利·安杰利医院进行了79例原发性和切口疝修补手术。所有病例均已在EuraHS注册中心（http://www.eurahs.eu）登记；其中，我们分析了29例使用新型聚丙烯复合补片（CMC，透明复合补片，意大利都灵圣毛罗托里内塞的DIPROMED srl公司）进行的手术，该补片用可吸收钉合器（ETHICON，美国波多黎各瓜伊纳沃的Ethicon LLC公司，邮编00969）固定。我们进行了23例切口疝修补术、4例原发性疝修补术（1例脐疝、2例上腹部疝和1例腰疝）和2例造口旁疝修补术。择期手术的中位手术时间为65.1分钟，急诊手术（3例）为81.4分钟。我们有2例术后并发症（6.89%），1例出血，另1例为肠梗阻延长，经保守治疗成功治愈。随访期间无复发。根据生活质量评估，在12个月时，患者对美学效果未抱怨任何疼痛或不适。使用用可吸收装置固定的聚丙烯复合补片进行腹腔镜治疗原发性和切口疝是可行且安全的。
